After years of poor communication with providers, outdated claims follow-up systems, and delayed payments, the U.S. Department of Veterans Affairs (VA) recently announced a new plan to improve the payment system for Community Providers.
Among the short-term changes the VA committed to make, a list of 20 large provider with high dollar value of unpaid claims was generated, and rapid response teams were formed to adjudicate all those claims within 90 days. Once claims from those large providers are adjudicated, the VA will work with other providers with outstanding claims.
VA Third Party Administrator Health Net Federal Services has been working with providers since since last fall to clean up old claims, implementing a phased approach to tackle claims with dates of service from 2014 through June 30, 2017. The final deadline to submit claims in that 3-tiered plan was January 8, 2018, and the payments were supposed to be processed by February 28, 2018. Going forward, the timely filing limits for Patient-Centered Community Care claims is 90 days following the date of service, or upon the conclusion of a series of authorized visits.
In addition to tackling the backlog, the VA also plans to increase the number of claims processed by vendors. Their goal was a 300 percent increase in January 2018 and a 600 percent increase in April 2018, with a goal of 90 percent clean claims processed in less than 30 days.
Beyond improvements in the timely adjudication and payment of claims, the VA also is improving communication with providers. Multiple entry points have been established for providers to check the status of claims, including a dedicated customer service team and the VA’s Vendor Inquiry System (VIS) located at https://www.vis.fsc.va.gov.
To address all of these issues for the long term, the VA will make the following changes to their claims and payment processes:
- Deploy multiple IT improvements within the first six months of 2018 that streamline the claims submission and payment process to reduce time for payments significantly.
- Align on concurrent performance improvement goals with VA’s existing Third Party Administrators to improve multiple aspects of their performance rapidly to ensure Veterans have continued uninterrupted access to care.
- Award four new contracts in 2018 for implementation in 2019 to establish the new Community Care Network that includes elements designed to ensure prompt payment of claims.
- Work with Congress to consolidate and simplify all VA community care programs, including provisions for prompt payment of claims.
- Ensure transparency with the VA’s claims processing performance by publishing VA’s claims processing timeliness on a monthly basis.
For more information about the changes to the VA payment process, review the following resources for community care providers: https://www.va.gov/COMMUNITYCARE/providers/resources.asp.
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